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Antibiotic-resistant Gram-negative bacteria are emergent pathogens, causing millions of infections worldwide. While there are several classes of antibiotics that are effective against Gram-positive bacteria, the outer membrane (OM) of Gram-negative bacteria excludes high-molecular-weight hydrophobic antibiotics, making these species intrinsically resistant to several classes of antibiotics, including polyketides, aminocoumarins, and macrolides. The overuse of antibiotics such as β-lactams has also promoted the spread of resistance genes throughout Gram-negative bacteria, including the production of extended spectrum β-lactamases (ESBLs). The combination of innate and acquired resistance makes it extremely challenging to identify antibiotics that are effective against Gram-negative bacteria. In this study, we have demonstrated the synergistic effect of outer membrane-permeable cationic polyurethanes with rifampicin, a polyketide that would otherwise be excluded by the OM, on different strains of E. coli, including a clinically isolated uropathogenic multidrug-resistant (MDR) E. coli. Rifampicin combined with a low-dose treatment of a cationic polyurethane reduced the MIC in E. coli of rifampicin by up to 64-fold. The compositions of cationic polyurethanes were designed to have low hemolysis and low cell cytotoxicity while maintaining high antibacterial activity. Our results demonstrate the potential to rescue the large number of available OM-excluded antibiotics to target normally resistant Gram-negative bacteria via synergistic action with these cationic polyurethanes, acting as a novel antibiotic adjuvant class.

Three-dimensional (3D) printing offers the unprecedented ability to create medical devices with complex architectures matched to the patient’s anatomy. However, the development of 3D printable synthetic polymers for biomedical applications has been relatively slow. Here, we present the synthesis and characterization of a library of single-component, undiluted, modular multifunctional polyesters for extrusion-based direct-write 3D printing (EDP). The polyesters were synthesized using carbodiimide-mediated polyesterification of pendant functionalized diols and succinic acid and characterized using 1H NMR, gel permeation chromatography (GPC), differential scanning calorimetry (DSC), and rheology. The rheology was characterized by using small amplitude oscillatory shear rheology and at steady-state shear flow conditions. The viscoelasticity of the polyesters was characterized by plotting master curves using the time–temperature superposition (TTS) principle, which were then validated by Van Gurp-Palmen and Cole–Cole plots. The 3D printability of the polyesters was assessed on the basis of several key parameters including the ability to extrude as continuous filaments, retain the printed shape, form multilayer constructs, and form bridge-spanning filaments without significant sagging or collapse. The rheological characterization suggests that the polyesters are unentangled melts that facilitate printing at ambient temperatures without the use of external additives or solvents. The presence of supramolecular interactions inducing pendant functional groups forms a temporary, physical cross-link-like network that enables 3D shape retention. The insights from this study will further assist in the design and characterization of 3D printable polymer melts for biomedical applications and standardizing the assessment of polymer 3D printability.

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